These 5 Cities Have 64% of COVID Cases, Are They Set for a Surge?
Lockdowns are meant to help health systems build capacity. What is the ground situation in top 5 COVID-19 cities?
On 12 May, Prime Minister Narendra Modi announced Lockdown 4.0 for India. What started as a 3 week lockdown on 24th March, is now in place for over 50 days, with lockdowns 2 and 3 announced on 14th April and 4th May. While an end date to the latest announcement is not out yet, nor is there information on what it will entail (likely to have far more relaxations), have these multiple lockdowns served their purpose?
Multiple public health experts FIT has spoken with over the last 50 days have said the reason for lockdowns is to give time to our health systems to strengthen and ’building up our healthcare capacity’ to deal with a surge.
“It’s time to exit this lockdown, India cannot have a protracted lockdown. The purpose of the lockdown was to slow down the transmission of the virus and give us time to build up a stronger health system response, and a sturdier social response," said Dr K Srinath Reddy in an interview with FIT, adding:
It’s time to move on to the next phase where we continue to implement a large number of personal protective measures as well as public health measures in order to slow down the transmission, but with resumption of economic and social activities as appropriate to each region of the country and district of the country.”
Repeated press conferences by the Union Health Ministry has laid out a picture of India having built up its healthcare capacity. According the latest data that has been reported, India has 1.30 lakh COVID-19 beds with oxygen support and over 35,000 ICU beds across the country. 6.4 lakh beds have been identified for isolation. The Prime Minister, in his speech, indicated that we have built our capacity to produce N95 masks and Personal Protection Equipment (PPE) from almost nil in the beginning of lockdown, to over 2 lakh every day.
The Ministry has further said that only 1.1 percent of total COVID-19 patients are on ventilator support, 3.3 percent on medical oxygen and 4.8 percent are using ICU beds.
Overall, this data sounds promising, but how is the situation on ground in top 5 cities that carry nearly 64% of India’s COVID-19 burden?
Mumbai and Pune: Cities Already Running Out of Beds
Mumbai, the city with the highest COVID-19 numbers in the country (on 13 May Mumbai crossed 15,000 cases, more than any other state in the country). On May 7, an article in the Economic Times indicated that the city had already run out of ICU beds. The government of Maharashtra, the state with the highest number of COVID cases in India, asked to take over private and military hospitals, after state run hospitals in Mumbai and Pune ran out of Intensive Care Units for COVID-19 patients.
They also called in 25,000 private doctors to report for COVID duty. With a threat that their failure to report would leading to cancelling of their licences.
The article also indicated that Mumbai was short of 400 doctors and healthcare professionals.
But do the city’s private hospitals have beds to give?
In another article by The Economic Times, they sought details from the city’s top hospitals (private and public) on availability of beds. As of May 1, BMC- run RN Cooper hospital had 11 beds for COIVD cases, KEM, 6 and Kasturba had 12 beds.
Among private hospitals, PR Hinduja had 42 beds for COVID patients, all were occupied. Wockhardt hospital had one bed available, Lilavati had one bed available. Some private hospitals like SH Reliance did have more beds available.
In a statement issued by BMC, the municipal corporation said, “In Mumbai, such (quarantine) facilities have been set up in Mahalaxmi Racecourse, Nehru Science Center, Nehru Planetarium, Goregaon Exhibition Centre, BKC, Richardson Krudas factory land near JJ hospital. Private hospitals have also earmarked some of their facilities for ICU (beds)."
A story in Times of India indicated that the waiting time for hospital beds in Mumbai had gone up from a few hours to upto 3 days with patients being asked to register for waitlists.
The dedicated COVID-19 hospitals have 4750 beds for critical patients. 1,750 beds were added in the first week of May.
Delhi: Data Discrepancy Comes in Way of Response
Delhi's Chief Minister Arvind Kejriwal recently opened up helplines to invite suggestions to tackle COVID-19 in the city from its citizens. 5 lakh suggestions poured in. But are these enough to help the state prepare for the surge if a lockdown is lifted?
Currently five private hospitals in the city have been turned into COVID centers. These include Fortis Hospital — Shalimar Bagh, Saroj Medical Institute and Khushi hospital (50 bed capacity each), Sir Ganga Ram City Hospital (120 beds) and Maha Durga Charitable Trust Hospital with 100 beds.
Two Delhi government hospitals — Lok Nayak (2000 beds) and Rajiv Gandhi Super Specialty hospital (500 beds) are identified as designated COVID hospitals.
According to one report dated April 28, the city has around 1,106 ventilators and only 306 out of them are in government hospitals, rest 800 are in private space.
Despite the numbers, problems have bogged Delhi's response to COVID-19. Recently, a report highlighted discrepancy in reporting of deaths at the city's Lok Nayak COVID hospital. The hospital had report around 47 deaths till May 6, when the government had reported only five deaths from the hospital and 66 from the city. A probe has been launched and the backlog of deaths is being looked at by COVID 19 death committee.
Despite new cases, as on 14 May, Delhi's case fatality rate continues to be just above one per cent. The national average is 3.1 percent.
Delhi has another problem. Over 400 healthcare workers in the city have tested positive till date, according to the state Health Minister Satyendra Jain.
Doctors warn of rise in numbers as we open up. "The flattening of the curve has not happened. The rise may have been slow but when we lift the lockdown, there will be increase in number of cases", said Dr Sumit Ray, Critical Care Specialist in conversation with FIT.
Ahmedabad: Cramped Quarters Could Lead to Surge
On April 28, Gujarat govt started implementing home quarantine for mild and asymptomatic patients. The idea was to free up beds for those who need critical care and those showing moderate symptoms.
On May 13, Gujarat became the state with second highest number of cases, with the city of Ahmedabad reporting 6645 cases and 446 deaths.
Civil Hospital, Ahmedabad has 1200 bed capacity and and Cancer hospital has 500 beds. According to reports, over 465 patients COVID-19 facilities at the civil hospital were transferred out to make room for more serious cases.
In an earlier report, Gujarat CM Rupani had said that the state government plans to increase the number of beds, ICUs and ventilator support to 25,000. There are no clear report available on how many beds does the city have.
In a notification issued on May 11 and May 6 by the Ahmedabad Municipal Corporation, 19 private hospitals were 'Designated Building Containment Units,' to be used for isolation facilities. In an earlier notification on May 7, 8 private hospitals were designated as COVID Hospitals.
According to another notification on the site, there are 66 Dedicated COVID Health Centres and 342 dedicated COVID Care Centres in Gujarat.
Chennai: Strong Health System, More Testing, Yet Surge Could Overwhelm Hospitals
FIT had done a deep dive into the rise in numbers in Tamil Nadu. The state boasts of one of the best public healthcare system in the country.
COVID19 testing is done in 37 government and 16 private labs all over Tamil Nadu. Till now 2,54,899 samples have been taken and sent for testing, and the state has conducted maximum number of tests in the country, with over 3367 people per million population. Mortality rate also remains among the lowest in the country at 0.69.
But are they ready for a surge?
In a report published on May 5 in New Indian Express, the indication was that the city was running out of beds. The municipal corporation has started shifting asymptomatic and stable patients to COVID-care facilities. These facilities have popped up at private colleges and Chennai Trade Centre.
In the same article, Narayana Babu, Director of Medical Education and Dean of Omandurar Medical College, was quoted as saying, "There are 1,750 beds for COVID-19 patients at government hospitals in the city and close to 1,200 beds have been occupied. In the past few days, the hospitals have increased the number of beds by at least 500. As many as 270 beds out of 500 at Omandurar hospital have been occupied and 190 beds out of the 400 at Stanley Hospital have been occupied."
Despite the dramatic rise in numbers in the state thanks to the Koyambedu market cluster, doctors remain hopeful.
Dr T Jacob John, a top virologist, says 100% mask wearing can be a solution and it will prevent overwhelming of health systems. “You can come two feet closer if you are wearing masks. But otherwise you have to maintain 6 feet. Physical distancing can become less stringent, if 100% mask wearing is not just promoted but enforced. This is proven and tested which has to be adopted. A study in the United States has shown that if 80% persons consistently wore masks, then the graph can be flattened”
(Subscribe to FIT on Telegram)
Subscribe To Our Daily Newsletter Now.